Everything you need to know about perimenopause: a comprehensive guide to understanding, experiencing, and supporting this stage of life

Perimenopauseis a pivotal period in a woman's life. Ainoha defines it as the entire female hormonal transition: it begins with the first hormonal changes (premenopause) and continues until hormonal stabilization after menopause, known as postmenopause.

This hormonal transition phase, which is often misunderstood, is nevertheless essential to understand. In this article, we discuss its definition, symptoms, duration, health impacts, medical treatment options, as well as practical advice and some common misconceptions.

What is perimenopause?

Perimenopause literally means "around menopause." It refers to the period of hormonal transition surrounding this event. However, in everyday language, it is often confused with premenopause, which in reality only represents the initial phase of the first hormonal changes.

In order to better clarify this key stage in women's hormonal lives, Ainoha has chosen to redefine perimenopause (difference between perimenopause and premenopause) as the entire period of hormonal transition in women: from the first hormonal fluctuations (premenopause) to the period of stabilization after menopause, known as postmenopause. 

Perimenopause is an important stage because it marks a real transition in a woman's hormonal life. It corresponds to the period surrounding menopause, with a "before" and an "after." Before, the body functions with hormonal cycles that are still active, even if they become more irregular. After menopause, a new hormonal balance is established, with permanently lower levels of estrogen and progesterone. This perspective provides a better understanding of the changes that can occur during this phase and allows for more appropriate support for women, well before menopause. 

 Check out our blog post on this topic: What is perimenopause?

At what age can premenopause begin, and how long does it last?

Premenopause is therefore the transition period before the definitive cessation of cycles, i.e., the cessation of ovulation, resulting in the cessation of menstruation. This premenopausal phase begins when the ovaries gradually reduce their production of sex hormones, particularly estrogen and progesterone, leading to a series of physiological changes. Unlike menopause, which is medically defined as the absence of menstruation for 12 consecutive months, the premenopausal period is marked by hormonal fluctuations and sometimes irregular cycles. This premenopausal phase can begin as early as age 35 in some women. However, this does not mean that fertility is immediately compromised or that menopause is imminent: this premenopausal period can last for many years before cycles stop completely.

 Discover our blog articles on this topic: What is the average age of premenopause? and How long does perimenopause last?

Why does premenopause occur?

Premenopause is a physiological transition phase leading up to menopause. It begins when the ovaries start to function less regularly due to a gradual decline in the number and quality of ovarian follicles. This change disrupts ovulation and leads to more irregular menstrual cycles, which may be longer or shorter, or occasionally even without ovulation, resulting in a lack of periods.

Hormonally, this period is mainly marked by significant fluctuations in sex hormones. Progesterone tends to decrease first. This is because the quality of the corpus luteum (the structure that forms after ovulation) declines with age and the onset of perimenopause, which reduces progesterone production.

At the same time, estrogen levels may remain relatively stable or even increase in some cases. This is because the brain attempts to stimulate the ovaries by secreting more FSH to recruit follicles, which can temporarily maintain estrogen production. Over the years, however, the follicles become less sensitive to the hormonal signals sent by the brain (pituitary gland). Ovulation becomes less frequent, cycles become more spaced out, and estrogen levels gradually decrease until menstruation stops completely, marking the onset of menopause.

These hormonal fluctuations characteristic of premenopause can influence many bodily functions and manifest themselves in changes in energy levels, sleep patterns, mood, libido, or intimate comfort, with intensity varying greatly from woman to woman.

The most common symptoms of perimenopause

The symptoms of premenopause vary greatly from one woman to another, both in nature and intensity. They are mainly related to the hormonal fluctuations that characterize this transition period.

At first, symptoms often reflect a relative decrease in progesterone. This can result in more severe premenstrual syndrome (PMS), shorter cycles, sometimes heavier periods, or even premenstrual spotting. Menstrual cycles also become more irregular, alternating between longer and shorter periods.

Over time, asestrogen productionbegins to decline, other signs may appear. Among the most common are hot flashes, night sweats, sleep disturbances, and persistent fatigue. Changes in the skin and mucous membranes may also occur, such as dry skin or vaginal dryness, sometimes associated with a decrease in libido.

This hormonal transition can also affect emotional and cognitive balance: irritability, mood swings, anxiety, difficulty concentrating, or feelings of "brain fog" may occur. Some women also report joint or muscle pain, gradual weight gain, or palpitations.

However, the intensity and combination of these symptoms vary greatly from woman to woman, with some experiencing few symptoms during this period, while others feel the effects of these hormonal fluctuations more acutely.

 Check out our blog post on this topic: symptoms of perimenopause.

How is perimenopause diagnosed?

The onset of premenopause cannot be detected "directly" by a blood test. Conversely, menopause is more easily identifiable biologically, with low estrogen and progesterone levels associated with elevated FSH and LH levels.

It is therefore essential to learn to observe and understand the signals sent by the body, which reflect the initial hormonal changes during this premenopausal phase.

The first changes may be subtle: changes in menstrual cycles, the onset or worsening of premenstrual syndrome (PMS), less restful sleep, fluctuations in energy or mood, unusual fatigue, decreased libido, or increased emotional sensitivity.

Premenopause is above all a natural biological transition that encourages self-awareness, mindful observation, and support, in order to better navigate this period of change. Discover our blog article on this topic: How do you know if you are going through premenopause?

Can you experience hot flashes during perimenopause?

Contrary to popular belief, hot flashes are not exclusive to menopause. They can occur as early as premenopause.

During this period, hormone levels do not yet drop permanently, but they fluctuate significantly, particularly estrogen. These hormonal variations can disrupt the temperature regulation center located in the hypothalamus, which can cause sudden hot flashes, sometimes accompanied by redness or sweating.

Therefore, the presence of hot flashes does not necessarily mean that a woman has already reached menopause. They may simply reflect the initial hormonal fluctuations of perimenopause, a transitional phase that can last several years before menstruation finally stops.

If you suffer from hot flashes or other uncomfortable symptoms, don't hesitate to consult a healthcare professional, who can guide you toward the solutions best suited to your situation.

Management of perimenopause

The management of perimenopause is based on a personalized approach, taking into account the severity of symptoms, overall health, and the preferences of each woman. When symptoms become bothersome, medical treatment may be considered in consultation with a healthcare professional.

Hormone replacement therapy (HRT) may be recommended in certain cases before menopause. Contrary to popular belief, hormone replacement therapy (HRT) is not only for menopause: in some cases, it may also be recommended during premenopause, when symptoms related to hormonal fluctuations become bothersome and affect quality of life. Depending on each woman's situation, healthcare professionals may recommend progesterone alone or a combination of progesterone and estrogen, tailoring treatment to each individual case.

HRT can help reduce hot flashes, improve sleep quality and mood, and play a role in preventing bone loss.

Non-hormonal approaches can also be considered to support this transition period and alleviate certain symptoms. The use of specific dietary supplements can provide valuable support.

During premenopause, particularly in cases of premenstrual syndrome (PMS), chaste tree, evening primrose oil, and borage oil are traditionally used to support female hormonal balance. Chaste tree mainly acts on cycle regulation and the balance between estrogen and progesterone. Evening primrose and borage oils, rich in essential fatty acids, contribute to female comfort and can help alleviate certain symptoms related to hormonal fluctuations.

During menopause, other approaches may be recommended to help reduce hot flashes and certain other symptoms associated with declining estrogen levels. These include red clover, soy isoflavones (particularly equol), and black cohosh, which are often used as supplements. Red clover andequol work mainly through their phytoestrogenic activity, i.e., their ability to bind to estrogen receptors and partially mimic their effects in the body. This mode of action explains their use in helping to alleviate certain symptoms of menopause, particularly hot flashes and certain discomforts associated with hormonal decline.

Local treatments, such as lubricants or vaginal care products, can help relieve intimate dryness that may occur.

Regardless of the treatment option chosen, it is essential to discuss it with a healthcare professional.

Furthermore, it is important to remember that as long as menstruation continues, pregnancy is still possible during premenopause. Premenopause does not mean the end of fertility, unlike menopause. It is therefore essential to continue using appropriate contraception during premenopause if pregnancy is not desired.

Check out our blog post on this topic: How to manage premenopause?

Practical tips for coping better with perimenopause 

Even without medical treatment, adjusting your lifestyle can help reduce the symptoms of perimenopause and promote overall well-being. A balanced diet rich in calcium, vitamins, and essential nutrients plays a key role in maintaining bone health and metabolism. Regular physical activity not only helps preserve bone and muscle mass, but also supports mood, stress management, and sleep quality.

Paying special attention to sleep and stress management is also essential, as hormonal fluctuations can disrupt biological rhythms. Reducing alcohol consumption and quitting smoking can also help limit certain symptoms, such as hot flashes, and preserve cardiovascular health.

Emotionally, psychological support can be beneficial when mood swings, anxiety, or emotional sensitivity become more pronounced. Behavioral therapies or psychological counseling offer a listening ear and concrete tools to help you get through this transition period.

Check out our blog post on this topic: Natural solutions for a successful transition to perimenopause.

Frequently Asked Questions (FAQ)

Is perimenopause a disease?

No: it is a natural phase of reproductive life, marked by gradual hormonal changes. These changes begin during the premenopausal period and eventually stabilize after menopause (in postmenopause) with a drastic and lasting drop in female hormones.

Can you get pregnant during perimenopause?  

Yes: during premenopause, women remain fertile even though ovulation may be of lower quality and hormone levels may not be optimal. As long as menstruation has not stopped for 12 months (the medical definition of menopause), fertility is still possible and appropriate contraception is recommended if pregnancy is not desired. Find out more in our detailed answer here: Can you get pregnant during premenopause?

Are all symptoms of perimenopause permanent?

No: Not all symptoms associated with perimenopause are permanent. They are mainly related to hormonal fluctuations during premenopause and the drastic drop in hormones during menopause.

During premenopause, hormonal fluctuations can lead to irregular cycles, more severe premenstrual syndrome, or even more painful periods, symptoms that will naturally end with the permanent cessation of periods at menopause.

During menopause, the drop in estrogen levels can cause hot flashes, night sweats, and vaginal dryness. Hot flashes are common and last an average of 5 to 7 years, although they can sometimes persist longer. Vaginal dryness, on the other hand, can persist over time because it is linked to sustained low estrogen levels after menopause.

However, the duration and intensity of symptoms vary greatly from one woman to another and generally tend to diminish over time.

More detailed frequently asked questions can be found in our dedicated blog post: Frequently asked questions about perimenopause.